To ask His Majesty’s Government what assessment they have made of the level of provision for treating patients with resistant hypertension including financial investment in renal denervation treatments.
My Lords, the NHS is increasing the diagnosis and detection of hypertension and is supporting the identification of resistant hypertension and its treatment. Renal denervation remains an option for some patients but is currently not widely commissioned by the NHS, in line with NICE guidance. The cardiovascular disease modern service framework will further support diagnosis and accelerate our commitment to reduce premature mortality from heart disease and stroke by 25% in the next 10 years.
My Lords, I thank my noble friend the Minister for her Answer. This Government, thankfully, have a direct focus on prevention. In view of that, the UK expert clinical consensus on renal denervation, published in the Heart journal, concluded that existing commissioning arrangements no longer accurately reflect current evidence and technology evaluation on renal denervation. I therefore ask my noble friend the Minister: will the Government reconsider and commit to reviewing national commissioning policies for renal denervation, so that funding and eligibility criteria for this technology are made clear and consistent across all eligible sectors?
I can indeed give the commitment to my noble friend that NHS England is currently reviewing the clinical evidence for the commissioning of renal denervation treatment, and recommendations are expected next year.
My Lords, while innovative treatments have an important role, uncontrolled high blood pressure remains one of the leading drivers of stroke, heart attacks and kidney failure. What work are the Government undertaking to improve prevention and management of high blood pressure, particularly in communities with the highest prevalence and the poorest outcomes?
The noble Baroness is right in what she says. This is a largely preventable condition and requires much movement from treatment to prevention, as the noble Baroness said. That means bearing down on certain lifestyle factors and encouraging people to seek to give up smoking, or not to take it up in the first place; to tackle obesity and support people in that; and to reduce alcohol consumption. It is important to note that identifying it at an early stage is crucial, because it allows us not only to support lifestyle changes but, where necessary, to provide medical intervention.
My Lords, I welcome the remarks made so far by the Minister. We are aware of the drivers and that hypertension can lead to strokes and heart attacks. In particular, about 5% to 10% of those with hypertension have resistant hypertension. I ask the Minister specifically: when the cardiovascular disease modern service framework is published, will the Government consider explicitly defining resistant hypertension as a distinctive, high-risk subgroup, so that we will be able to ensure that a focus can be put on it and to help strategies to minimise serious cardiovascular diseases?
The noble Lord makes a helpful point. Indeed, the modern service framework will soon be published. Of course, as blood pressure is one of the seven risk factors for cardiovascular disease, as the noble Lord referred to, we have to improve detection and management. That is what the modern service framework will drive forward, particularly in local areas. Yes, it will make reference not just to hypertension, which is more widely applicable, but to resistant hypertension, as he suggested.
My Lords, NICE has recognised renal denervation as a potential treatment option for resistant hypertension, yet its use remains limited and subject to special arrangements for governance and research. What assessment have the Government made of the extent to which eligible patients are able to access renal denervation across England? Are Ministers concerned about the emergence of a postcode lottery in access to the treatment?
Looking to the future, obviously, one can only act on clinical guidance. Renal denervation, as I mentioned to my noble friend, is an emerging option for carefully selected patients at the moment, as the noble Lord said. What matters now is that evidence is emerging, and that is why it is being reassessed. We will not have to wait too long to see what the future will bring in this regard, but it certainly has a role to play.
My Lords, I will refine the previous questions. Resistant hypertension occurs when the blood pressure does not respond to standard treatment of two, three or even four drugs—hence we call it resistant hypertension. The reason why the renal system is involved is because the sympathetic nervous system acts between the kidneys and the brain. That controls vasodilatation and the production of hormones that raise the blood pressure. By denerving the renal system, which are nerves on the arteries of the kidneys, you can cut out one of the nervous system’s interactions between kidneys and the brain. What is important, therefore, is that people who suffer from resistant hypertension are treated by specialists at a specialist centre that considers denervation as one of the options, because it is not always the only answer. Therefore, does the Minister agree that people with resistant hypertension should be treated in a specialist centre?
I certainly would agree with that. Indeed, those who are diagnosed with resistant hypertension—and the noble Lord has, as ever, outlined how that is defined in a far better way than I could have done—can be referred by their GP to secondary care hospital hypertension services, so, to answer the point made by the noble Lords, Lord Patel and Lord Evans, that does mean in-depth investigations and expert management. The House can be assured of that.
My Lords, I declare my interest as chair of the Health Data Research Service. We know that hypertension remains underdiagnosed, and it is right that the Government have diversified the detection pathways. However, between those first high recordings at a pharmacy or in social care, the information does not always flow through to the treatment location, so people remain undertreated as well as underdiagnosed. Can the Minister say what steps the department will take to address this failing?
That clearly matters immensely. We have invested in community pharmacy services, which have brought this into the heart of communities and made it easier and more attractive for people to have their blood pressure checked. As of February, we have some 10,000 community pharmacies delivering. We are also developing the online NHS health check and the modern service framework. Information from pharmacies should be going direct to GPs, but I am heartened, as we move towards the health Bill, by the advent of the single patient record.
My Lords, following on from the extraordinary explanation by the noble Lord, Lord Patel, of the background and the need for specialist centres, would a pilot project undertaken by NHS research help, in case there are any delays in assessing the information before us? This is something that the NHS should do more often—specific pilot projects to see how something works in practice.